Infants of Diabetic Mothers
Conditions
Keywords
gestation, diabetes, ethanol
Brief summary
Gestational diabetes mellitus (GDM) affects as many as 14% of women in the United States. Furthermore, the number of pregnant women with pregestational diabetes mellitus (PGDM) is also increasing, mainly due to an increase in the diagnosis of non-insulin dependent diabetes mellitus. A recent study demonstrated that 1.3% of pregnancies are now complicated by PGDM and that PGDM now comprises 21% of the diabetes that complicate gestations, which represents a two fold increase since 1999. One notable side effect of diabetes is an elevation of endogenous ethanol production, which in turn may result in a rise in fetal production of fatty acid ethyl ester (FAEE). FAEE found in meconium have been utilized as a marker of prenatal ethanol exposure. Therefore, FAEE elevation could call into question maternal claims of abstinence from alcohol during pregnancy. This study seeks to determine if meconium FAEE levels in the newborns of abstinent women with various classifications of diabetes mellitus are increased when compared to non-diabetic, abstaining controls.
Detailed description
Researchers will approach four groups of pregnant women at 24-26 weeks when they present for routine obstetrical out-patient appointments: 1. Those with PGDM 2. Those with White's Class A1 GDM 3. Those with White's Class A2 GDM 4. Non-diabetic controls The medical records of these women will be examined to determine self-reporting of any alcohol or other drug usage while pregnant; women who report any illicit drug use (or ethanol use) while pregnant will not be eligible for this study. A routine urine drug screen will further confirm this finding. Women who have not reported alcohol use during their pregnancy will be questioned regarding medication usage while pregnant, as some medications do contain small amounts of ethanol. Women who are judged to have not consumed alcohol during their pregnancies (intentionally or incidentally) would then be included in the study. Demographic information about the mother would also be collected (age, parity, length of pregnancy), as would the mother's most recent glycosylated hemoglobin level; additionally, a glycosylated hemoglobin level will be drawn on our presumptive controls (to allow for covert gestational diabetes mellitus). This lab draw would be added to the mother's routine lab studies and would not require an additional venipuncture. A second urine drug screen will be performed on the mother upon her admission to the University of Oklahoma Health Sciences Center for the delivery of her baby. If both screens are negative and the baby does not meet any of the exclusion criteria, the baby will be enrolled in the study. The initial meconium from each baby of the recruited mothers will be gathered. Approximately 1 g of meconium will be collected, frozen, and evaluated for fatty acid ethyl ester analysis at the United States Drug Testing Laboratories, Inc. We will also be sending a dried blood spot from the baby which will be collected at the time of the baby's scheduled newborn screen. This dried blood spot will be evaluated for phosphatidylethanol, an ethanol by-product.
Interventions
OTHERN/A - No intervention
Sponsors
University of Oklahoma
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
No minimum to 45 Years
Healthy volunteers
Yes
Inclusion criteria
(understood to include only abstemious women) 1. . Pregnant women expected to deliver between 37 and 41 weeks gestation (controls), and their babies 2. . Pregnant women expected to deliver between 37 and 41 weeks gestation who have class A1 diabetes mellitus, and their babies 3. . Pregnant women expected to deliver between 37 and 41 weeks gestation who have class A2 diabetes mellitus, and their babies 4. . Pregnant women expected to deliver between 37 and 41 weeks gestation who were diagnosed with diabetes mellitus prior to their pregnancy, and their babies.
Exclusion criteria
1. . Mothers who self-reported any alcohol or any illicit drug use during their pregnancy (and their babies) 2. . Mothers who had a positive drug screen at any point during their pregnancy (and their babies) 3. . Babies whose mothers suffered a placental abruption during their pregnancy. 4. . Babies whose mothers had inadequate prenatal care (defined as \<3 prenatal clinic visits prior to admission for delivery) 5. . Non-English-speaking mothers 6. . Babies who pass meconium in utero. 7. . Babies born with multiple congenital anomalies or abdominal wall defects.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Meconium Fatty Acid Ethyl Ester Concentration | Three months | A measure of ethanol metabolites in the meconium of an infant. |
| Phosphatidylethanol Level | Three months | A measure of phosphatidylethanol, an ethanol metabolite, in the cord blood of an infant. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Control Pregnant women without either gestational or pre-gestational diabetes mellitus (and their offspring).
N/A - No intervention | 2 |
| A1 IDM Pregnant women with abnormal glucose tolerance test but normal fasting serum glucose levels (and their offspring).
N/A - No intervention | 0 |
| A2 IDM Pregnant women with abnormal glucose tolerance test and fasting hyperglycemia (and their offspring).
N/A - No intervention | 0 |
| PGDM - IDM Pregnant women with diabetes mellitus diagnosed prior to current pregnancy (and their offspring).
N/A - No intervention | 2 |
| Total | 4 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Physician Decision | 2 | 0 | 0 | 2 |
Baseline characteristics
| Characteristic | Control | Total | PGDM - IDM |
|---|---|---|---|
| Age, Continuous | 31 years STANDARD_DEVIATION 1 | 29.8 years STANDARD_DEVIATION 3.5 | 28.5 years STANDARD_DEVIATION 4.5 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 2 Participants | 4 Participants | 2 Participants |
| Region of Enrollment United States | 2 participants | 0 participants | 2 participants |
| Sex: Female, Male Female | 2 Participants | 4 Participants | 2 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 2 | 0 / 0 | 0 / 0 | 0 / 2 |
| other Total, other adverse events | 0 / 2 | 0 / 0 | 0 / 0 | 0 / 2 |
| serious Total, serious adverse events | 0 / 2 | 0 / 0 | 0 / 0 | 0 / 2 |
Outcome results
Primary
Meconium Fatty Acid Ethyl Ester Concentration
A measure of ethanol metabolites in the meconium of an infant.
Time frame: Three months
Population: This study enrolled four mother/infant dyads but never had results due to low enrollment number
Primary
Phosphatidylethanol Level
A measure of phosphatidylethanol, an ethanol metabolite, in the cord blood of an infant.
Time frame: Three months